Global prevalence of nosocomial infection: A systematic review and meta-analysis

Are AI-based surveillance systems for healthcare-associated infections ready for clinical practice? A systematic review and meta-analysis

Healthcare-associated infections (HAIs) are a global public health concern, imposing significant clinical and financial burdens. Despite advancements, surveillance methods remain largely manual and resource-intensive, often leading to underreporting. In this context, automation, particularly through Artificial Intelligence (AI), shows promise in optimizing clinical workflows. However, adoption challenges persist. This study aims to evaluate the current performance and impact of AI in HAI surveillance, considering technical, clinical, and implementation aspects. We conducted a systematic review of Scopus and Embase databases following PRISMA guidelines. AI-based models' performances, accuracy, AUC, sensitivity, and specificity, were pooled using a random-effect model, stratifying by detected HAI type. Our study protocol was registered in PROSPERO (CRD42024524497). Of 2834 identified citations, 249 studies were reviewed. The performances of AI models were generally high but with significant heterogeneity between HAI types. Overall pooled sensitivity, specificity, AUC, and accuracy were respectively 0.835, 0.899, 0.864, and 0.880. About 35.7 % of studies compared AI system performance with alternative automated or standard-of-care surveillance methods, with most achieving better or comparable results to clinical scores or manual surveillance. <7.6 % explicitly measured AI impact in terms of improved patient outcomes, workload reduction, and cost savings, with the majority finding benefits. Only 30 studies deployed the model in a user-friendly tool, and 9 tested it in real clinical practice. In this systematic review, AI shows promising performance in HAI surveillance, although its routine application in clinical practice remains uncommon. Despite over a decade, retrieved studies offer scant evidence on reducing burden, costs, and resource use. This prevents their potential superiority over traditional or simpler automated surveillance systems from being fully evaluated. Further research is necessary to assess impact, enhance interpretability, and ensure reproducibility.

Multimodal strategies for the implementation of infection prevention and control interventions-update of a systematic review for the WHO guidelines on core components of infection prevention and control programmes at the facility level

BACKGROUND

Health care-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the WHO to enhance infection prevention.

OBJECTIVES

To update the systematic review on facility level infection prevention and control interventions on the WHO core component of using multimodal strategies.

METHODS

Data sources: Medline (by PubMed), EMBASE, CINAHL, and the Cochrane library.

STUDY ELIGIBILITY CRITERIA

Randomized controlled studies, interrupted time series, and before-after studies in acute care settings, from November 24, 2015 to June 30, 2023.

PARTICIPANTS

Both paediatric and adult populations.

INTERVENTIONS

Infection prevention and control interventions implemented with at least three WHO multimodality elements. Assessment of risk of bias: Effective practice and organisation of care and integrated quality criteria for review of multiple study designs tools. Methods of data synthesis: Descriptive data synthesis.

RESULTS

Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies were excluded due to an insufficient integrated quality criteria for review of multiple study designs score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to antimicrobial resistance and six on hand hygiene (HH) compliance. Eleven were controlled studies (randomized controlled studies or controlled before-after studies), nine interrupted time series and seven non-controlled before-after studies. Twenty-two of the studies originated from high-income countries, and the overall quality was medium to low. Twenty studies showed either significant HAI reductions or HH improvement.

CONCLUSION

Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate, with few studies from low-income or middle-income countries. Future research should focus on higher quality studies in resource limited settings.

Targeted next-generation sequencing enhances precision and rapid detection in healthcare-associated infection Surveillance: Unveiling multidrug-resistant colonization in ICUs

Objectives

This study aims to evaluate the potential advantages of targeted next-generation sequencing (tNGS) over conventional bacterial culture methods for pathogen detection in hospital-associated infections (HAIs).

Methods

All EICU medical staff and all medical staff from the Physical Examination Centre completed a questionnaire. Nasopharyngeal specimens were collected from medical staff who met all of the inclusion criteria and none of the exclusion criteria. EICU medical staff provided 2 samples each, while Physical Examination Centre staff provided 1 sample each. For EICU medical staff, one of their two nasopharyngeal swabs was subjected to tNGS testing, and the other to bacterial culture testing. For the PEC staff, their nasopharyngeal swabs were subjected to tNGS testing. Additionally, six pairs of spectacles and six keyboards used by EICU medical staff were randomly selected, and the surfaces were swabbed with sterile swabs for tNGS testing.

Results

In 23 nasal swab samples from EICU group, tNGS detected 14 species of microorganism in 29 instances within 19 h. Bacterial culture detected 2 species of microorganism in 4 instances, 2 positive samples within 19 h and confirmed another 2 positive samples within 69 h. A total of 42 samples with 14 different microorganism species were collected from the nasopharyngeal swabs of 23 EICU members and 15 PEC members. Among them, 29 cases (69 %) of 14 different microorganisms were detected in EICU staff, with an average of 1.3 microorganism species detected per person, while 13 cases (28 %) of 6 different microorganisms were detected in PEC staff, with an average of 0.9 microorganism species detected per person. The most common colonizing bacteria included Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella spp. Compared to bacterial culture, tNGS offers advantages in monitoring HAIs, including a broad range of detectable microorganisms, high sensitivity of results, and shorter reporting time for positive results. Bacteria colonizing the EICU carry more antibiotic resistance genes.

Conclusions

tNGS outperforms conventional culture in healthcare-associated infection surveillance, with higher sensitivity and accelerated pathogen identification. Simultaneously, tNGS revealed extensive colonization of multidrug-resistant (MDR) pathogens (e.g., Acinetobacter baumannii, MRSA) in EICU environments, highlighting its utility in monitoring complex antimicrobial resistance patterns.

Prevalence of Hospital-Acquired Infections in Low- and Middle-Income Countries: Systematic Review and Meta-Analysis

The burden of hospital-acquired infections (HAIs) is particularly substantial in low- and middle-income countries (LMICs). However, a comprehensive understanding of their prevalence in these regions is lacking. This systematic review aimed to evaluate the prevalence of HAIs in LMICs. Major databases, including Scopus, PubMed, and Web of Science, were thoroughly searched for published studies between January 1, 2000, and July 15, 2024. The PRISMA guidelines were followed. The pooled prevalence of HAIs was estimated using a random-effects model and a 95% confidence interval. The literature search identified 87 studies reporting HAI prevalence in LMICs. The overall prevalence of HAIs across LMICs was 22% (95% CI = [17, 28]). The South-East Asian Region presented the highest prevalence at 37% (95% CI = [13, 62]). In terms of income level, low-income countries had the highest prevalence at 37% (95% CI = [23, 52]). Surgical site infections had the highest prevalence among infection types at 27% (95% CI = [23, 31]). This systematic review underscores the high prevalence of HAIs in most LMICs, emphasizing the need to facilitate the development of targeted prevention and control strategies to mitigate the impact of this critical public health issue, especially in resource-limited settings.

Between heuristic and deliberative thinking: a multi-center qualitative study of physicians' decision-making in infection prevention practice

BACKGROUND

Application of standard infection prevention and control (IPC) measures is crucial to prevent hospital-acquired infections, but compliance by physicians is suboptimal. Interventions aimed to improve compliance are often generic and lack sustained effects. A better understanding of physicians' trade-offs regarding application of IPC and influences on their behavior is needed to develop effective behavior change interventions. We aimed to understand physicians' decision-making processes around application of IPC and the factors that influence their behavior.

METHODS

This qualitative study involved semi-structured interviews with 18 physicians and 7 nurses from five different hospitals in the Netherlands. Reflexive thematic analysis involved inductive coding followed by deductive analysis using mechanisms of action, including the Theoretical Domains Framework, that link to behavior change techniques.

RESULTS

We found heterogeneity in physicians' approaches to decision-making around application of IPC. Some physicians relied on heuristics, while others applied logical reasoning. The latter group made an autonomous assessment of the risks for infection associated with a situation and traded off the costs and benefits of IPC application. The decision was further influenced by personal beliefs about the value of IPC and a supporting physical and social environment. Eighteen out of 26 mechanisms of action underlying the influences on IPC behavior were matched to our results; most important are "memory, attention and decision processes", "behavioral cueing", "beliefs about consequences", "values", "norms", "social influences", "social learning/imitation" and "environmental context and resources". These findings suggest that interventions are most likely to be beneficial if these focus on developing heuristics, changing risk beliefs, using social norms and imitation and generating a supportive environment.

CONCLUSION

The heterogeneity in physicians' decision-making and autonomous risk assessment which is different from other healthcare professionals calls for tailored interventions targeting heuristic decision making, personal beliefs, social norms and the environmental context.

Does the use of pulsed-xenon ultraviolet light reduce the risk of healthcare-associated infections?: An updated systematic review and meta-analysis

OBJECTIVE

The present review was conducted to assess the ability of the pulsed-xenon ultra-violet system (PX-UVL) to reduce healthcare-associated infections (HAI).

METHODS

All types of studies available on PubMed, Embase, Scopus, and Web of Science databases assessing the risk of any HAI with the use of PX-UVL and published up to 25 February 2025 were included. Data on C. difficile infection (CDI), Methicillin-resistant Staphylococcus aureus (MRSA) infection, Vancomycin-resistant enterococci (VRE) infections, and Acinetobacter baumannii infections (ABI) was pooled.

RESULTS

Fourteen studies were included. Most studies had a pre-post study design while two were controlled trials. Meta-analysis showed a statistically significant reduction in the risk of CDI with PX-UVL (RR: 0.76 95 % CI: 0.59, 0.97 I2 = 72 %). However, results were significant only for pre-post studies (RR: 0.75 95 % CI: 0.57, 0.98 I2 = 73 %) but not for controlled trials (RR: 0.70 95 % CI: 0.25, 1.96 I2 = 72 %). The results were also not stable on sensitivity analysis. Meta-analysis also showed a tendency of reduction of MRSA infections but the effect size was statistically non-significant (RR: 0.80 95 % CI: 0.62, 1.02 I2 = 65 %). Pooled analysis demonstrated no significant impact of PX-UVL in reducing the risk of VRE infections (RR: 0.83 95 % CI: 0.66, 1.04 I2 = 54 %) or ABI (RR: 0.64 95 % CI: 0.21, 1.90 I2 = 96 %). Subgroup analysis based on study design showed that the risk of VRE infection did not change in both pre-post studies and controlled trials.

CONCLUSIONS

Current evidence from variable study designs suggests that PX-UVL may have limited efficacy in reducing HAI. Further high-quality randomized controlled trials will provide quality evidence.

Effects of probiotic supplementation on infectious and gastrointestinal complications of critically ill patients: Randomized, blinded, placebo-controlled clinical trial

BACKGROUND

Critically ill patients frequently experience alterations in gut microbiota, known as dysbiosis, which has been associated with unfavorable clinical outcomes. The use of probiotics is one approach to modulating gut microbiota.

OBJECTIVE

This study aimed to evaluate the effects of probiotic supplementation combined with enteral nutrition (EN) in critically ill patients on infectious, gastrointestinal complications, and clinical outcomes.

METHODS

This is a randomized, blinded, placebo-controlled clinical trial conducted with 70 individuals aged ≥18 years, receiving enteral nutrition, and admitted to the emergency intensive care unit (ICU) of a tertiary hospital. The intervention consisted of Lactobacillus paracasei SD 5275, Lactobacillus rhamnosus SD 5675, Lactobacillus acidophilus SD 5221, and Bifidobacterium lactis SD 5674 (109 Colony Forming Units (CFU) of each bacterium/sachet, two sachets per day were used), administered via EN once daily for at least 5 days until ICU discharge, death, or initiation of an oral diet. The primary outcomes were the occurrence of infections and gastrointestinal symptoms. Secondary outcomes included the use of antibiotics, laxatives, prokinetics, duration of mechanical ventilation (MV), ICU stay, and mortality.

RESULTS

There was no significant difference in the occurrence of any type of infection or gastrointestinal symptoms between the groups (p ≥ 0.05). The use of antibiotics and laxatives was similar between the groups (p = 1.000 and 0.917, respectively). The average duration of prokinetic use was shorter in the intervention group (2.80 ± 1.52 vs. 6.08 ± 5.58 days, 95 % Confidence interval (CI) -1.39; -0.0594, p = 0.011). Although the number of days on mechanical ventilation, ICU stay, and mortality were lower in the patients who received probiotics, no significant differences were observed between the groups (p ≥ 0.05).

CONCLUSION

It is concluded that ICU patients supplemented with probiotics have a shorter duration of prokinetic use. However, supplementation does not directly impact gastrointestinal symptoms, infections, antibiotic use, laxative use, duration of mechanical ventilation, ICU stay, or mortality.

REGISTERED AT

Brazilian Clinical Trials Registry (ReBEC) under the number: ID RBR-2kqnj2t. SITE: https://ensaiosclinicos.gov.br/welcome.

Point-prevalence surveys of hospital-acquired infections in 42 Chinese hospitals in Weifang, China: from 2015 to 2020

BACKGROUND

Hospital-acquired infections (HAIs) are a major health challenge, especially for developing countries. Therefore, this study investigated the prevalence of HAIs in 42 Chinese hospitals in Weifang, China.

METHODS

The definition of HAIs was identified using the Ministry of Health of the People's Republic of China. One-day cross-sectional surveys were annually performed from 2015 to 2020. The trained staff collected information on the prevalence of HAIs, isolated pathogens, and antibiotic use.

RESULTS

Among the surveyed inpatients, 1.66% developed HAIs, with a significant decline in HAI prevalence from 2015 (1.84%) to 2020 (1.55%) (Z = -4.206, P < 0.001). The ICU exhibited the highest prevalence of HAIs at 19.04%. Lower respiratory tract infections accounted for 46.32% of total cases. Moreover, a total of 1,297 bacterial isolates were identified, with Pseudomonas aeruginosa (218 isolates, 16.8%), Klebsiella pneumoniae (199 isolates, 15.3%), and Escherichia coli (133 isolates, 10.3%) being the most prevalent. The most frequently detected resistant pathogen was Carbapenem-Resistant Enterobacteriaceae(218 isolates,37.20%).Antimicrobial usage reached 35.19%, accompanied by a notable increase in pathogen testing submissions over the study period (Z = 4.287, P < 0.001).

CONCLUSIONS

The overall prevalence of HAIs across 42 hospitals shows a declining trend. The prevention and control of healthcare-associated pathogens and multidrug-resistant organisms remain key priorities. Ensuring the rational use of antimicrobial agents is also a critical focus for future efforts.

Trends in point-prevalence surveys of healthcare-associated infections in acute care hospitals from the VINCat program in Catalonia, Spain (2008-2022)

INTRODUCTION

Point prevalence surveys (PPS) offer valuable insights into the burden of healthcare-associated infections (HAIs) and antibiotic utilization. Our objective was to analyze trends of HAIs, medical device use, and antibiotic administration among hospitalized adult patients from 2008 to 2022, drawing on data from the VINCat Program in Catalonia, Spain.

METHODS

The study compares aggregated data from PPS carried out over three 5-year periods (2008-2012, 2013-2017, and 2018-2022) gathered in a one-day survey carried out in May of each calendar year. Trained infection control personnel collected demographic and clinical data and information on device use and antibiotic administration. Criteria from the ECDC were used to define active HAI.

RESULTS

Surveys were conducted at 56 acute care hospitals and included 59,454 patients: 14,914 (period 1), 19,916 (period 2) and 24,624 (period 3). Overall, 3986 patients (6.7%, 95% confidence interval: 6.5-6.9) had one or more HAIs. The trend of HAIs showed a U-shape, falling overall since 2008 but rising during the COVID-19 pandemic. Although there was a significant increase in the use of invasive devices, surgical site infections (SSI) were the most frequently reported HAIs across the three periods. The prevalence of antimicrobial therapy exhibited a significant rise from 33.3% of patients during period 1 to 39.2% in period 3.

CONCLUSION

Although there was an overall downward trend in HAIs during the study period, there was also a significant increase in antibiotic consumption. The data showed that SSI was the most prevalent HAI. This information was used to reinforce prevention activities.

Comparison of urinary tract-related and catheter-related bloodstream infections in long-term and acute care wards: A retrospective cohort study

BACKGROUND

The characteristics of bloodstream infections in patients admitted to long-term care wards remain unclear. This study examined differences in nosocomial-onset urinary tract-related bloodstream infections (UTRBSIs) and catheter-related bloodstream infections (CRBSIs) between patients admitted to long-term and acute care wards.

METHODS

This retrospective cohort study was conducted at a mixed-care hospital with long-term and acute care wards from April 2015 to March 2024. Patient backgrounds, causative pathogens, antibiotic resistance, and treatment patterns were compared between the two groups.

RESULTS

Among the 252 patients, 108 (42.9 %) were diagnosed with UTRBSIs and 87 (34.5 %) with CRBSIs. In UTRBSIs, the long-term care group had significantly longer hospitalization (721 vs. 16 days, P < 0.001), more frequent use of indwelling urinary catheters (76.7 % vs. 28.6 %, P < 0.001), and higher isolation rates of extended-spectrum β-lactamase-producing Enterobacterales (41.1 % vs. 8.6 %, P < 0.001). Piperacillin/tazobactam and meropenem were significantly more frequently used empirically in the long-term care group. In CRBSIs, the isolation rates of main causative pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) (9.5 % vs. 6.7 %, P = 0.707) and methicillin-resistant coagulase-negative Staphylococcus spp. (40.5 % vs. 48.9 %, P = 0.519), showed no significant differences between the two groups despite differences in patient backgrounds. Anti-MRSA agents were rarely used empirically in both groups (19.0 % vs. 15.6 %, P = 0.779).

CONCLUSIONS

Patients admitted to long-term care wards may require empirical therapy for UTRBSIs targeting drug-resistant Enterobacterales, while for CRBSIs, empirical use of anti-MRSA agents may be considered, similar to patients admitted to acute care wards.

Pathogenic bacteria rapidly colonize sinks of a neonatal intensive care unit: results of a prospective surveillance study

BACKGROUND

Hospital sinks are known to harbour bacteria with the potential to infect patients.

AIM

To examine bacterial growth in the sinks of a newly constructed neonatal intensive care unit (NICU) during the transition from an established NICU within the same facility.

METHODS

This was a prospective study of pathogenic bacterial growth in NICU handwashing sinks before and after the new NICU was occupied. Samples from various sink traps were cultured longitudinally, and comparison was made between the established NICU and the new NICU.

FINDINGS

Potentially pathogenic bacteria colonized sinks rapidly in the new NICU within 1 month of occupation. During the study period, between 29th June 2021 and 2nd September 2022, 62 samples were collected from 11 sinks, of which 43 (69.4%) tested positive. The mean semi-quantitative bacterial growth score was notably higher in the sink in the milk preparation room compared with the sinks in the patient care area in the new NICU (40.67 vs 1.768; P=0.025). The bacterial profiles in the sink in the new NICU milk preparation room mirrored that of the established NICU, with a predominance of Klebsiella pneumoniae and Enterobacter cloacae complex. In handwashing sinks of both the established NICU and the new NICU, the dominant colonizing pathogen was Burkholderia cepacia complex, followed by Serratia marcescens and Elizabethkingia spp. Cessation of sink use reduced the bioburden of bacteria significantly in the NICU handwashing sink drains.

CONCLUSION

Handwashing sinks were colonized rapidly with pathogenic bacteria in a newly constructed NICU. More diversified and prolific growth of pathogenic bacteria was noted in the sink in the milk preparation room.

Artificial intelligence in hospital infection prevention: an integrative review

Background

Hospital-acquired infections (HAIs) represent a persistent challenge in healthcare, contributing to substantial morbidity, mortality, and economic burden. Artificial intelligence (AI) offers promising potential for improving HAIs prevention through advanced predictive capabilities.

Objective

To evaluate the effectiveness, usability, and challenges of AI models in preventing, detecting, and managing HAIs.

Methods

This integrative review synthesized findings from 42 studies, guided by the SPIDER framework for inclusion criteria. We assessed the quality of included studies by applying the TRIPOD checklist to individual predictive studies and the AMSTAR 2 tool for reviews.

Results

AI models demonstrated high predictive accuracy for the detection, surveillance, and prevention of multiple HAIs, with models for surgical site infections and urinary tract infections frequently achieving area-under-the-curve (AUC) scores exceeding 0.80, indicating strong reliability. Comparative data suggest that while both machine learning and deep learning approaches perform well, some deep learning models may offer slight advantages in complex data environments. Advanced algorithms, including neural networks, decision trees, and random forests, significantly improved detection rates when integrated with EHRs, enabling real-time surveillance and timely interventions. In resource-constrained settings, non-real-time AI models utilizing historical EHR data showed considerable scalability, facilitating broader implementation in infection surveillance and control. AI-supported surveillance systems outperformed traditional methods in accurately identifying infection rates and enhancing compliance with hand hygiene protocols. Furthermore, Explainable AI (XAI) frameworks and interpretability tools such as Shapley additive explanations (SHAP) values increased clinician trust and facilitated actionable insights. AI also played a pivotal role in antimicrobial stewardship by predicting the emergence of multidrug-resistant organisms and guiding optimal antibiotic usage, thereby reducing reliance on second-line treatments. However, challenges including the need for comprehensive clinician training, high integration costs, and ensuring compatibility with existing workflows were identified as barriers to widespread adoption.

Discussion

The integration of AI in HAI prevention and management represents a potentially transformative shift in enhancing predictive capabilities and supporting effective infection control measures. Successful implementation necessitates standardized validation protocols, transparent data reporting, and the development of user-friendly interfaces to ensure seamless adoption by healthcare professionals. Variability in data sources and model validations across studies underscores the necessity for multicenter collaborations and external validations to ensure consistent performance across diverse healthcare environments. Innovations in non-real-time AI frameworks offer viable solutions for scaling AI applications in low- and middle-income countries (LMICs), addressing the higher prevalence of HAIs in these regions.

Conclusions

Artificial Intelligence stands as a transformative tool in the fight against hospital-acquired infections, offering advanced solutions for prevention, surveillance, and management. To fully realize its potential, the healthcare sector must prioritize rigorous validation standards, comprehensive data quality reporting, and the incorporation of interpretability tools to build clinician confidence. By adopting scalable AI models and fostering interdisciplinary collaborations, healthcare systems can overcome existing barriers, integrating AI seamlessly into infection control policies and ultimately enhancing patient safety and care quality. Further research is needed to evaluate cost-effectiveness, real-world applications, and strategies (e.g., clinician training and the integration of explainable AI) to improve trust and broaden clinical adoption.

Surgical implant sterilization in the Asia-Pacific region: A survey of current practices

BACKGROUND

Healthcare-acquired infections are frequently linked to contaminated medical devices such as inadequately sterilized surgical devices, especially surgical implants. To prevent inadequate medical equipment sterilization, various health organizations (eg, World Health Organization) have provided guidance on best practices related to the sterilization monitoring practices of implant-containing loads.

METHODS

A survey of sterilization practices, including practices related to monitoring implant-containing loads, at facilities from seven countries in the Western Pacific Region (WPR) and three countries in the Southeast Asia Region (SEAR) was conducted to assess alignment with health organization guidelines and to elucidate factors impacting sterilization practices.

RESULTS

Workload distribution was selected by 47 % of respondents when asked what had changed over the past year. Overall, 21 % of respondents were not monitoring each implant-containing load with a PCD (Process Challenge Device) containing a BI (Biological Indicator) with a Type-5 Chemical Indicator (CI), and 27 % of respondents had seen an implant load released prior to receiving BI results. Twenty-nine percent (29 %) of respondents had no placement guide for CIs when used in multi-level trays. Lastly, 43 % of respondents routinely performed immediate use system sterilization (IUSS), which commonly involved loaner instruments.

CONCLUSIONS

The results of this survey study indicate that inappropriate PCD usage in implant loads and frequent IUSS are challenges for some facilities in SEAR and WPR countries. Regional collaboration to produce consensus documents and educational programs may help develop strategies to standardize practice of implant load monitoring and loaner instruments. Thus, a consortium to initiate education programs for SEAR and WPR countries would be worthwhile.

The Microbiome of an Outpatient Sports Medicine Clinic During a Global Pandemic: Effects of Implementation of a Microbiome-Specific Cleaning Program

Outpatient healthcare facilities represent potential sources of healthcare-associated infections (HAIs). The purpose of this study was to survey high-contact surfaces in an outpatient physical therapy clinic, characterize the microbiome of those surfaces, and investigate the effects of a microbiome-specific cleaning and hygiene plan. Hand sanitizer containing a fluorescent probe used by patients and staff identified surface contact. High-contact surfaces were analyzed for bacterial DNA and SARS-CoV-2. A microbiome-specific cleaning and hygiene plan was developed based on initial analysis. After the implementation of the revised cleaning regimen, microbial community diversity and predicted metagenome content (PICRUSt) were employed for differential analysis. Patients had greater surface contact than staff. Ralstonia pickettii was the dominant species pre-cleaning, comprising 49.76% of the total, and observed on 79.5% of surfaces. The cleaning and hygiene plan significantly increased Shannon diversity, and R. pickettii decreased to 4.05% of total bacteria. SARS-CoV-2 was not observed on any surfaces. This study found ecological dominance by a single species in this outpatient clinic, suggesting a potential source of HAIs. However, a microbiome-specific cleaning strategy was successful in diversifying the microbiome and reducing ecological dominance. Additional research is needed to confirm these findings.

Health care-associated infections and antimicrobial use: The third point prevalence survey on 42 acute care hospitals in Piedmont, Italy, 2022

BACKGROUND

Health care-associated infections (HAIs), antibiotic use (AMU), and antimicrobial resistance (AMR) are critical indicators of health care quality and antimicrobial stewardship. Point prevalence surveys provide essential data for optimizing infection prevention and control strategies. We aimed to describe the prevalence of HAIs, AMU, and AMR in Piedmont, Italy, highlighting associations with hospital complexity and patient characteristics.

METHODS

Data included hospital characteristics, demographics, HAI, AMU, AMR, and clinical characteristics. Prevalence ratios were calculated to compare rates across subgroups.

RESULTS

The prevalence of HAIs was 8%. AMU prevalence decreased to 40% from 42.8% in 2016. Trends in AMU aligned with the "Italian National Action Plan to contrast AMR" (PNCAR) goals, showing reduced fluoroquinolone use and increased amoxicillin prescriptions. AMR trends showed improvements in oxacillin-resistant Staphylococcus aureus and cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae.

CONCLUSIONS

The results highlight the critical importance of sustained investment in infection prevention and control measures and robust antimicrobial stewardship programs.

Ventriculoperitoneal Shunt Infections: Causative Pathogens and Associated Outcomes from Multiple Hospitals in Saudi Arabia

Background: Ventriculoperitoneal shunting (VPS) is the primary treatment for hydrocephalus, significantly improving patients' outcomes. However, it is marred by high failure rates due to infections, which account for a third of these malfunctions and escalate morbidity, mortality, and healthcare costs. Method: This study focused on evaluating VPS infection rates, pathogens, their resistance patterns, and the impact on clinical outcomes using retrospective data from multiple hospitals in Saudi Arabia. It included data from hydrocephalus patients who underwent VPS and only considered positive cultures that were confirmed from CSF or shunt tip samples. Results: This study excluded patients with prior infections before VPS placement or those treated with alternatives to VPS. Out of 317 patients who met the inclusion criteria, the analysis revealed that 23 patients (7.26%) suffered from VPS infections, mostly within the first two weeks post-surgery (58.06% of cases), with a significant discrepancy in infection rates between hospitals. Infections predominantly involved Gram-positive bacteria (58.08%), especially coagulase-negative staphylococci and Staphylococcus aureus (25.81% and 12.90%, respectively). There was also a substantial presence of Gram-negative bacteria and fungi, accounting for 35.46% and 6.46%, respectively. Despite general antibiotic susceptibility, resistance was significant in certain cases, including multidrug-resistant isolates like Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter ursingii. Importantly, patients with VPS infections had a tenfold increase in the length of hospital stay (70.84 days, SD ± 139.5) compared to non-infected patients (7.69 days, SD ± 20.72), indicating high morbidity and associated treatment costs. Conclusions: Our results emphasize the importance of better VPS infection control and standardized hospital protocols to decrease the incidence of VPS-related infections, both in Saudi Arabia and globally.

More than rewards: insights into a hospital infection prevention and control gamification strategy

BACKGROUND

Traditional infection prevention and control (IPC) education and training of healthcare workers (HCWs) is expensive and rarely sustainable. Gamification strategies support behavioural change by capitalizing on psychological drivers such as intrinsic and extrinsic motivation. However, little is known about which type of reward presentation best supports the engagement of HCWs.

AIM

To examine which reward strategy can best facilitate engagement and acquisition of IPC knowledge.

METHODS

This study was performed in three gastroenterology wards, and a palliative care ward served as the control. Data on bed occupancy and consumption of alcohol-based hand sanitizer (ABHS) were collected over a 2-month baseline period, and the number of correct answers was gathered during the intervention phases. Surveys on expectation and satisfaction were conducted pre and post intervention. Twice-weekly knowledge quizzes used loss aversion, standard reward and in-game reward strategies. Multi-variate analysis was used to analyse data on ABHS consumption and IPC knowledge.

FINDINGS

In total, 105 HCWs participated in this study. A 170% increase in mean ABHS consumption was observed between baseline and the last phase of gamification. This represents a significant effect of gamification (P<0.05). However, no significant difference in ABHS consumption was observed between the gamified wards (P>0.05). Furthermore, gamified strategies showed higher engagement than the control strategy, but strategies of loss aversion and standard rewards did not display higher ABHS consumption or game engagement compared with gamification alone.

CONCLUSION

The intervention effectively engaged medical and non-medical staff in IPC topics, positively influencing HCW work flow and increasing ABHS consumption. These findings highlight gamification as a promising approach for IPC education.

Compliance with transmission-based precautions, and associated factors among healthcare providers in Cameroon: a cross-sectional study

BACKGROUND

Transmission-based precautions (TBP) and the proper use of personal protective equipment (PPE) are essential in preventing hospital-acquired infections (HAIs) and in controlling the emergence and spread of antimicrobial resistance (AMR). This study, therefore, aimed to determine healthcare providers' compliance with TBP and its determinants in healthcare settings to help curb the burden of HAIs and AMR.

METHOD

This study was a cross-sectional, hospital-based research conducted among healthcare providers at four health facilities in the Fako division of Cameroon, from January 1 to May 31, 2024. A standardized observation form, adapted from the World Health Organization's checklist for hand hygiene practices, was used to assess compliance with Transmission-Based Precautions (TBP) among healthcare providers when interacting with patients known or suspected of having infectious pathogens. Multivariable logistic regression analysis was performed to identify factors independently associated with TBP compliance, with significance set at a p-value of less than 0.05.

RESULTS

The proportion of participants with good TBP compliance was 75.4% (95%CI: 67.4-82.2). Contact precaution compliance was 94.2%, while that for droplet /airborne was 12.8%. Factors independently associated with good TBP compliance were healthcare providers trained in IPC (aOR: 2.89, 95%CI: 1.16-7.22), the availability of PPE in the facility's departments (aOR: 6.00, 95%CI: 1.24-29.17), and working in the facility; Mount Mary Hospital (aOR: 22.47, 95%CI: 2.21-228.08).

CONCLUSION

Compliance with transmission-based precautions was suboptimal. The determinants of good compliance with TBP among healthcare providers were making PPE available in the facility and training healthcare providers on IPC. Tailored public health measures should be implemented to improve and sustain healthcare providers' compliance with TBP.

Central sterile supply departament management on hospital-associated infections: a systematic review and meta-analysis

Hospital-associated infections (HAIs) pose significant risks in clinical settings, and sterile supply centers management plays a crucial role in infection control. This systematic review and meta-analysis aimed to evaluate the impact of supply center management on the incidence of HAIs and adverse events. The systematic review encompassed studies that compared supply center management protocols with standard care. The PRISMA guidelines were followed to search seven databases for relevant studies. The meta-analysis calculated pooled odds ratios (OR) for HAIs and adverse events, and heterogeneity was assessed using Tau2, Chi-squared, and I2 statistics. Eight studies were included in the final analysis, each assessing intervention efficacy. The results revealed a significant reduction in HAIs (pooled OR=0.3; 95%CI [0.19; 0.49]). Adverse events were also significantly reduced (pooled OR=0.15; 95%CI [0.09; 0.25]). Heterogeneity was low for both HAIs (Tau2=0.00; I2=0%) and adverse events (Tau2=0.04; I2=19%), which indicated a consistent effect across the studies. Sterile supply center management significantly reduced the incidence of HAIs and adverse events. This suggests these interventions are effective in improving clinical outcomes and could be a vital component of infection control strategies in healthcare facilities.

Exploring the Impact of Workplace Satisfaction, Leadership, and Career Development on Employee Retention in Hospitals

Background and objectives This study examines hospital employees' perceptions of workplace satisfaction, communication, and professional development, providing insights into key factors affecting job satisfaction, retention, and the overall work environment. Methods A longitudinal survey design was employed to assess hospital employees' perceptions of workplace satisfaction, communication, and professional development at Bihor County Emergency Clinical Hospital. Data were collected over a four-year period (2019-2022) to capture evolving trends in employee attitudes and experiences. The total sample size includes 3,732 participants, who were asked to complete a questionnaire, with data stratified by year and analyzed for statistical significance using p-values. Results The survey results reveal strengths in infection control awareness and compliance, with 95% of employees understanding their responsibilities in preventing healthcare-associated infections. Positive interpersonal communication and collaboration were also highlighted, with 90.9% of employees reporting good relationships with colleagues. However, the survey also identified areas for improvement, particularly in career advancement opportunities, with only 41.8% of respondents believing the hospital had a structured promotion policy. Conclusions These findings suggest that while the hospital excels in certain aspects, addressing gaps in career development, resource management, leadership responsiveness, and training opportunities is essential for enhancing employee satisfaction, reducing turnover, and improving patient care outcomes. Recommendations include establishing merit-based promotion systems, improving infrastructure, and expanding professional development programs.

Fungi Assessment in Indoor and Outdoor Environment of Four Selected Hospitals in Peninsular Malaysia

Hospital buildings require special attention to protect patients and healthcare workers from hospital-acquired infections and sick building illnesses. This is the first study to assess the prevalence of fungus in indoor air, outdoor air, and their contamination on surfaces at selected locations in four highly contaminated hospitals (A, B, C, and D) in Peninsular Malaysia. A total of 294 indoor air samples, 106 scrapped and 169 swabbed, were collected from July 2019 to August 2020. Bioaerosol concentrations were calculated using the colony-forming unit (CFU)/m3. Molecular identification was performed on the cultures. The internal transcribed spacer (ITS) region in the rRNA gene of the isolates was amplified by PCR. Results showed that fungal burden was in the range between 18 and 2597 CFU/m3. Fungal load in selected locations at Hospital D were in the higher range between 106 and 2597 CFU/m3, with two locations exceeding the national guidelines. Fungal genera were highly identified in air samples (47) compared to swabbed (29) and scrapped (18) samples. The dominant species were C. halotolerans, C. tenuissimum, P. alfredii, P. brevicompactum, P. brocae, P. cataractarum, and A. aculeatus. Fungal loads were higher in the Orthopedic and Oral Surgeon Clinic, the On Call Emergency Room, wards, and pathways.

Pseudomonas aeruginosa Vaccine Development: Lessons, Challenges, and Future Innovations

Pseudomonas aeruginosa is an opportunistic pathogen with a multidrug-resistant profile that has become a critical threat to global public health. It is one of the main causes of severe nosocomial infections, including ventilator-associated pneumonia, chronic infections in patients with cystic fibrosis, and bloodstream infections in immunosuppressed individuals. Development of vaccines against P. aeruginosa is a major challenge owing to the high capacity of this bacterium to form biofilms, its wide arsenal of virulence factors (including secretion systems, lipopolysaccharides, and outer membrane proteins), and its ability to evade the host immune system. This review provides a comprehensive historical overview of vaccine development efforts targeting this pathogen, ranging from early attempts in the 1970s to recent advancements, including vaccines based on novel proteins and emerging technologies such as nanoparticles and synthetic conjugates. Despite numerous promising preclinical developments, very few candidates have progressed to clinical trials, and none have achieved final approval. This panorama highlights the significant scientific efforts undertaken and the inherent complexity of successfully developing an effective vaccine against P. aeruginosa.

A bundle-based approach on catheter-associated urinary tract infection: a multi-center study in Chinese tertiary hospitals

BACKGROUND

Catheter-associated urinary tract infections (CAUTIs) are one of the most common types of healthcare-associated infections (HAIs). Current studies mainly focus on risk factors, but the method to control them is unresolved. We aim to give an overview of the epidemiology of CAUTIs and explore the effects of bundle intervention on intensive care unit (ICU) inpatients.

METHODS

A multi-center, double-blind, retrospective study was conducted in eight Xiamen medical centers over six months; we recruited ICU inpatients with indwelling urinary catheters (UC) > = 48 h. Data were analyzed using Chi-Square and student's t-test.

RESULTS

With bundle interventions, the CAUTI rate in ICUs decreased from 3.84 to 1.31 per 1000 UC days. The UC utilization was significantly reduced after bundles (71.29-62.70%), and the average duration of indwelling UC was reduced considerably (7,035 days vs. 6,884 days). CAUTIs in patients over 60 years old were significantly reduced after bundles. There were 45 causative organisms detected from 36 cases of CAUTIs, including 12 multidrug-resistant bacteria.

CONCLUSIONS

Bundles have been shown to reduce the risk of CAUTIs in patients with indwelling catheters in the ICU, especially older adults. It also significantly reduces the use of Carbapenem. Therefore, CAUTI bundles are recommended to clinicians.

Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, Burkina Faso, 2022: A longitudinal study

BACKGROUND

Healthcare-associated infections (HAIs) are one of the most common adverse events in healthcare and represent a major public health problem. The present study was conducted to analyze the incidence, risk factors, and outcomes of HAIs through active surveillance in three hospitals in the city of Bobo Dioulasso, Burkina Faso.

METHODS

A prospective, longitudinal, multicenter study was conducted from May 1 to November 30, 2022, in two district hospitals (Do and Dafra) and the Sourô Sanou Teaching Hospital (CHUSS), Burkina Faso. Consenting patients hospitalized for reasons other than infection, cancer, immunosuppression in the postoperative care ward of Do or of Dafra district hospitals, intensive care unit (ICU)/CHUSS, neonatal ward/CHUSS, and gynecology and obstetrics postoperative care ward/CHUSS during a 2-month inclusion period in district hospitals and 4 months for CHUSS wards. For this study, we used the operational definitions of the French Technical Committee for Nosocomial Infections and Healthcare-associated Infections, with slight modifications. Logistic regression was used to analyze risk factors of HAIs.

RESULTS

Of the 664 patients enrolled, 166 experienced an HAI, with a cumulative incidence rate of 25% (95%CI: 21.7%-28.3%) or an incidence density rate of 36.7 per 1000 patient-days (95% CI: 31.7-42.9). Surgical site infections (SSI) (44%), followed by neonatal infections (42%) were the most common HAIs. Enterobacterales represented 60% of the bacteria identified in HAIs, and 38.9% of them were extended spectrum β-lactamase (ESBL) producers. Factors associated with HAIs were admission in the neonatal ward (aOR = 6.6; 95%CI:1.1-40.2), ICU (aOR = 3.3; 95%CI:1.3-8.5), previous hospital stay longer than two days (aOR = 2.0; 95%CI:1.2-3.3), or male sex (aOR = 1.8; 95%CI:1.1-3.0). In addition, HAIs were associated with longer follow-up, hospitalization, and mortality (18.1%; 95% 95%CI:12.1-24.4). Deaths were only recorded in the ICU and neonatal ward, with case fatality rates of 45.4% (95% 95%CI: 27.5-63.4) and 21.4% (95% 95%CI: 11.6-31.3), respectively, p = 0.019.

CONCLUSIONS

The incidence of HAIs was relatively high in the three hospitals in Bobo Dioulasso, Burkina Faso. It is essential to implement rigorous protocols for patient management, to reduce the incidence of HAIs and the spread of resistant pathogens in general and Enterobacterales in particular.

Synthesis, characterization, and biomedical applications (antibacterial, antibiofilm, anticancer and effects on hospital-acquired pneumonia infection) of copper titanium oxide nanostructures

Hospital-acquired pneumonia (HAP) is the second most common cause of nosocomial infections and is responsible for 15% of nosocomial infections, with a high mortality rate, which has led to increased concern and significant costs in healthcare settings. The most significant agents of HAP are Pseudomonas aeruginosa and Klebsiella pneumoniae, which create a biofilm that results in a resistant infection. We aimed to study the synthesis of Cu2Ti2O5 nanoparticles, their effects on the growth and biofilms of Pseudomonas aeruginosa and Klebsiella pneumoniae isolated from respiratory infections, and their anticancer effects. In this study, for the first time, the Pechini method was used to synthesize Cu2Ti2O5 nanostructures. The effects of nanoparticles on the growth and biofilms of Pseudomonas aeruginosa and Klebsiella pneumoniae were evaluated using a microdilution broth and the microtiter plate method, and the cytotoxic effect of the nanoparticles on the A549 cell line was also assessed by MTT. The characteristics of the nanoparticles were confirmed through XRD, FTIR, SEM, and TEM techniques. Cu2Ti2O5 showed a minimum inhibitory effect in concentrations of 156.25 to 625 μg mL-1 for ten isolates of K. pneumoniae and 625 to 1250 μg mL-1 for ten isolates of P. aeruginosa and at sub-MIC concentrations as well. It reduced the biofilms of K. pneumoniae and P. aeruginosa strains by 75% and 44.4%. The nanoparticles killed 50% of A549 cancer cells in 48 h at concentrations of 30 to 40 μg mL-1 and in 24 h at concentrations of 200 to 250 μg mL-1. The findings of this study show the antibacterial, anti-biofilm, and anti-cancer effects of Cu2Ti2O5 nanoparticles. Therefore, these nanoparticles can be considered potential antimicrobial candidates; however, these effects should be confirmed with more bacterial isolates.

Trends in Healthcare-Acquired Infections Due to Multidrug-Resistant Organisms at a German University Medical Center Before and During the COVID-19 Pandemic

BACKGROUND

Healthcare-acquired infections due to multidrug-resistant organisms (MDR-HAIs) pose globally significant challenges to healthcare systems, leading to increased morbidity, mortality, and healthcare costs. According to the World Health Organization, the COVID-19 pandemic significantly impacted the burden of MDR-HAIs. The aim of this study was to investigate the dynamics and epidemiology of MDR-HAIs in inpatients at the University of Leipzig Medical Center (ULMC) before and during the COVID-19 pandemic.

METHODS

We compared data from inpatients with bacterial infections from 2017 to 2019 (pre-COVID-19) and from 2021to 2023 (during COVID-19) in a cross-sectional, monocentric, retrospective survey. This study focused on selected multidrug-resistant organisms (MDROs) and four clinical specimens. We analyzed the risk factors for MDR-HAIs using logistic regression models.

RESULTS

Out of 342,705 inpatients, 32,206 were diagnosed with a bacterial infection. The prevalence increased significantly from 8.09% (pre-COVID-19) to 10.79% (during COVID-19) (p < 0.001), but the proportion of MDROs decreased from 10.14% to 8.07%. The proportions of MDR-HAIs were 59.86% and 56.67%, respectively. The proportion of carbapenem-resistant Klebsiella pneumoniae and Enterobacter cloacae increased significantly. The risk of MDR-HAIs during COVID-19 decreased by 18% compared to pre-COVID-19 (p = 0.047). Longer hospital stays increased the risk of MDR-HAIs in both periods. This risk significantly decreased for children and the elderly during COVID-19.

CONCLUSION

These findings show that it is also important to analyze epidemiological data at the facility level in order to evaluate the effectiveness of infection control practices even during unprecedented health crises like the COVID-19 pandemic.

Ultraviolet-C-based sanitization is a cost-effective option for hospitals to manage health care-associated infection risks from high touch mobile phones

Mobile phones have become essential tools for health care workers around the world, but as high touch surfaces, they can harbor microorganisms that pose infection risks to patients and staff. As their use in hospitals increases, hospital managers must introduce measures to sanitize mobile phones and reduce risks of health care-associated infections. But such measures can involve substantial costs. Our objective in this paper was to consider two mobile phone risk mitigation strategies that managers of a hypothetical hospital could implement and determine which involves the lowest cost. The first strategy required all staff to sanitize their hands after every contact with a mobile phone. The second involved the hospital investing in ultraviolet-C-based mobile phone sanitization devices that allowed staff to decontaminate their mobile phones after every use. We assessed each intervention on material and opportunity costs assuming both achieved an equivalent reduction in microbe transmission within the hospital. We found that ultraviolet-C devices were the most cost-effective intervention, with median costs of approximately AUD360 per bed per year compared to AUD965 using hand hygiene protocols. Our results imply that a 200-bed hospital could potentially save AUD1-1.4 million over 10 years by investing in germicidal ultraviolet-C phone sanitizers rather than relying solely on hand hygiene protocols.

Antibiotic resistance genotype, phenotype, and clinical outcomes in patients with Gram-negative infections at Rabin Medical Center in Israel

Antibiotic resistance is a major cause of morbidity and mortality. However, a better understanding of the relationship between bacterial genetic markers, phenotypic resistance, and clinical outcomes is needed. We performed whole-genome sequencing on five medically important pathogens (Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) to investigate how resistance genes impact patient outcomes. A total of 168 isolates from 162 patients with Gram-negative infections admitted to Beilinson Hospital at Rabin Medical Center in Israel were included for final analysis. Genomes were analyzed for resistance determinants and correlated with microbiologic and clinical data. Thirty-day mortality from time of culture was 26.5% (43/162). Twenty-nine patients had carbapenem-resistant isolates (29/168, 17.2%), while 63 patients had multidrug-resistant isolates (63/168, 37.5%). Albumin levels were inversely associated with mortality and length of stay, while arrival from a healthcare facility and cancer chemotherapy predicted having a multidrug-resistant isolate. Sequencing revealed possible patient-to-patient transmission events. blaCTX-M-15 was associated with multidrug-resistance in E. coli (OR = 3.888, P = 0.023) on multivariate analysis. Increased blaOXA-72 copy number was associated with carbapenem-resistance in A. baumannii (P = 0.003) and meropenem minimum inhibitory concentration (P = 0.005), yet carbapenem-resistant isolates retained sensitivity to cefiderocol and sulbactam-durlobactam. RJX84154 was associated with multidrug-resistance across all pathogens (P = 0.0018) and in E. coli (P = 0.0024). Low albumin levels were associated with mortality and length of stay in this sample population. blaCTX-M-15 was correlated with multidrug-resistance in E. coli, and blaOXA-72 depth predicted meropenem minimum inhibitory concentration in A. baumannii. RJX84154 may play a role in multidrug-resistance.

IMPORTANCE

While there have been several studies that attempt to find clinical predictors of outcomes in patients hospitalized with bacterial infections, less has been done to combine clinical data with genomic mechanisms of antibiotic resistance. This study focused on a hospitalized patient population in Israel with infections due to medically important bacterial pathogens as a way to build a framework that would unite clinical data with both bacterial antibiotic susceptibility and genomic data. Merging both clinical and genomic data allowed us to find both bacterial and clinical factors that impact certain clinical outcomes. As genome sequencing of bacteria becomes both rapid and commonplace, near real-time monitoring of resistance determinants could help to optimize clinical care and potentially improve outcomes in these patients.

Determinants of Nurses' Compliance with Infection Prevention and Control Practices in Critical Care Units

Introduction

It is widely recognized that critical care environments significantly increase the risk of infection for both patients and healthcare personnel.

Purpose

This study aimed to assess the determinants of nurses' compliance with infection prevention and control practices in critical care units.

Methods

A cross-sectional study was conducted with 155 nurses working in critical care units. Data were collected using a structured questionnaire that measured sociodemographic characteristics, compliance, knowledge, and perceptions of infection prevention and control (IPC) practices. Statistical analyses, including multiple linear regression, were performed to assess predictors of compliance with IPC practices. This study was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines to ensure transparency and rigor in the reporting of the methodology and findings.

Results

A total of 155 nurses participated in the study, yielding a response rate of 91.1%. Seventy-one percent demonstrated good compliance with IPC practices, while only 39.4% exhibited moderate knowledge of IPC guidelines. Experience in critical care (β = 3.542, p < .05) and institutional support (β = 0.246, p < .01) were significant predictors of compliance, highlighting the importance of both factors in promoting adherence to IPC practices.

Conclusion

Although compliance with IPC practices was generally high, gaps in knowledge and perception suggest the need for enhanced educational initiatives and institutional support to further improve IPC adherence. Future research should focus on developing strategies that address these gaps to ensure sustainable compliance.

Profiling and comprehensive analysis of microbiome and ARGs of nurses and nursing workers in China: a cross-sectional study

Hospital-acquired infection (HAI) and antimicrobial resistance (AMR) represent major challenges in healthcare system. Despite numerous studies have assessed environmental and patient samples, very few studies have explored the microbiome and resistome profiles of medical staff including nursing workers. This cross-sectional study was performed in a tertiary hospital in China and involved 25 nurses (NSs), 25 nursing workers (NWs), and 55 non-medical control (NC). Stool samples from all participants and hand samples (i.e., the microbiome sample from hand skin, which were collected by swabbing both hands with a sponge-swab soaked with neutralized buffer and centrifuging the liquid buffer) from NSs and NWs were collected for metagenomic analysis. Metagenomic analysis revealed that medical staff exhibited lower abundances of beneficial species such as Blautia, and Bifidobacterium in the gut microbiome. However, an important potential pathogen, Staphylococcus haemolyticus, was enriched in the hands of NWs, suggesting a considerable prevalence of pathogenesis and multi-drug resistance. Accordantly, ARG analysis revealed worse hand hygiene among NWs than among NSs, characterized by a higher diversity of ARGs and a higher abundance of ARGs conferring multi-drug resistance including mdtF, acrB, AcrF and evgS. This study provides a comprehensive overview of the microbial and ARG profiles in the gut and hands of NSs and NWs. The higher abundance of potential pathogens and diverse multi-drug resistant ARGs in NWs hands indicates insufficient hand hygiene and a higher risk of HAI in this subgroup. This study is the first to highlight the critical need to improve hand hygiene among NWs, thus mitigating the risks of AMR and HAI.

Tissue nano-transfection of antimicrobial genes drives bacterial biofilm killing in wounds and is potentially mediated by extracellular vesicles

The emergence of bacteria that are resistant to antibiotics is on track to become a major global health crisis. Therefore, there is an urgent need for new treatment options. Here, we studied the implementation of tissue-nanotransfection (TNT) to treat Staphylococcus aureus-infected wounds by delivering gene cargos that boost the levels of naturally produced antimicrobial peptides. The Cathelicidin Antimicrobial Peptide gene (CAMP), which produces the antimicrobial peptide LL-37, was used as model gene cargo. In vitro evaluation showed successful transfection and an increase in the transcription and translation of CAMP-coding plasmid in mouse primary epithelial cells. Moreover, we found that the extracellular vesicles (EVs) derived from the transfected cells (in vitro and in vivo) carried significantly higher concentrations of CAMP transcripts and LL-37 peptide compared to control EVs, possibly mediating the trafficking of the antimicrobial contents to other neighboring cells. The TNT platform was then used in vivo on an excisional wound model in mice to nanotransfect the CAMP-coding plasmid on the edge of infected wounds. After 4 days of daily treatment, we observed a significant decrease in the bacterial load in the CAMP-treated group compared to the sham group. Moreover, histological analysis and bacterial load quantification also revealed that TNT of CAMP on S. aureus-infected wounds was effective in treating biofilm progression by reducing the bacterial load. Lastly, we observed a significant increase in macrophage recruitment to the infected tissue, a robust increase in vascularization, as well as and an increased expression of IL10 and Fli1. Our results demonstrate that TNT-based delivery of gene cargos coding for antimicrobial compounds to the wound is a promising approach for combating biofilm infections in wounds.

State of infection prevention knowledge among healthcare professionals in Japan: a questionnaire survey analysis using text mining

BACKGROUND

Healthcare-associated infections (HAIs) are an important issue that needs to be addressed continuously in healthcare institutions Healthcare professionals (HCPs) are expected to strengthen educational programmes on infection prevention. Although the incidence of HAIs in Japan has been decreasing, the actual state of knowledge on infection prevention among HCPs remains unclear.

AIM

To clarify the actual infection prevention knowledge of HCPs in Japan.

METHODS

The study participants were 1158 HCPs working in healthcare institutions with frequent contact with patients (283 doctors, 591 nurses, 115 physical therapists, 97 radiologists and 72 medical technologists). HCPs described the infection prevention behaviours they adhered to consciously via an online self-administered questionnaire. Data were analysed by text mining. Categories were extracted from the responses to reveal HCPs' infection prevention knowledge.

FINDINGS

More than half of the participants (64.9%) were aged >40 years, and 48.1% had >20 years of clinical experience. The majority of the participants were nurses (51.0%), 43.9% had a bachelor's degree, and 56.6% were female. Seven categories regarding infection prevention knowledge were extracted: 'performing hand hygiene and gargling', 'wearing personal protective equipment', 'strengthening one's immunity', 'protecting oneself and patients from infection', 'distinguishing clean and unclean zones', 'actions to prevent transmission to others in daily life activities' and 'maintaining distance from others'.

CONCLUSION

These results suggest that most HCPs working in healthcare settings in Japan prioritize and adhere to standard precautionary measures, and the low incidence of HAIs may be influenced by perceptions of the knowledge of 'handwashing and gargling' among HCPs.

Bacteria profiles and antimicrobial susceptibility pattern of isolates from beds and door handles of hospital wards in Tiko Health District, Cameroon

Introduction

in low- and middle-income countries, hospital surfaces contaminated with bacteria, namely beds and door handles in hospital wards, are a major source of nosocomial infections. We sought to evaluate bacterial isolates from beds and door handles of hospital wards and ascertain their antibiotic susceptibility patterns in Tiko Health District (THD), Cameroon.

Methods

using a multistage sampling technique, this hospital-based cross-sectional study included 40 beds and 20 door handles in THD. Gram staining methods, biochemical reactions, and features of bacterial colonies were used to identify bacterial isolates. A frequency table and bar charts were used to display the data.

Results

Bacillus spp., Clostridium perfringens, Klebsiella pneumoniae, Clostridium spp., and Staphylococcus aureus were identified. Patient beds were mainly contaminated with S. aureus (42.5%, 17/40). However, C. perfringens (35%, 7/20) was the most common isolate from door handles. S. aureus was resistant to bacitracin (100%, 21/21) but sensitive to gentamycin (95.2%, 20/21) and azithromycin (95.2%, 20/21). While C. perfringes was resistant to bacitracin (100%, 8/8), it was sensitive to gentamycin (75%, 6/8) and chloramphenicol (75%, 6/8).

Conclusion

beds and door handle harbour largely S. aureus and C. perfringes, respectively. High sensitivity to gentamycin and resistance to bacitracin were observed in S. aureus and C. perfringes, respectively. Good and regular hand hygiene and the cleaning and disinfecting of door knobs and hospital beds should be practiced. Hospitals should fully adopt food safety protocols to prevent or control food poisoning effectively.

Development and validation of a geographic search filter for MEDLINE (PubMed) to identify studies about Germany

While geographic search filters exist, few of them are validated and there are currently none that focus on Germany. We aimed to develop and validate a highly sensitive geographic search filter for MEDLINE (PubMed) that identifies studies about Germany. First, using the relative recall method, we created a gold standard set of studies about Germany, dividing it into 'development' and 'testing' sets. Next, candidate search terms were identified using (i) term frequency analyses in the 'development set' and a random set of MEDLINE records; and (ii) a list of German geographic locations, compiled by our team. Then, we iteratively created the filter, evaluating it against the 'development' and 'testing' sets. To validate the filter, we conducted a number of case studies (CSs) and a simulation study. For this validation we used systematic reviews (SRs) that had included studies about Germany but did not restrict their search strategy geographically. When applying the filter to the original search strategies of the 17 SRs eligible for CSs, the median precision was 2.64% (interquartile range [IQR]: 1.34%-6.88%) versus 0.16% (IQR: 0.10%-0.49%) without the filter. The median number-needed-to-read (NNR) decreased from 625 (IQR: 211-1042) to 38 (IQR: 15-76). The filter achieved 100% sensitivity in 13 CSs, 85.71% in 2 CSs and 87.50% and 80% in the remaining 2 CSs. In a simulation study, the filter demonstrated an overall sensitivity of 97.19% and NNR of 42. The filter reliably identifies studies about Germany, enhancing screening efficiency and can be applied in evidence syntheses focusing on Germany.

Healthcare-Associated Infections' Characteristics Among Burn Patients and Risk Factors of Mortality: A Study Based on Data From a Tertiary Center in Iran: Nosocomial Infections Among Burn Patients

Background: Burn patients are more likely to get healthcare-associated infections (HAIs). The current study aimed to investigate the characteristics of HAI and mortality risk factors among burn patients admitted to a tertiary center in Iran. Methods: A retrospective study was conducted in 2021 on burn patients who developed HAI after hospitalization in a tertiary center in Ahvaz, Iran. The records of patients admitted and managed between March 2019 and March 2020 were reviewed. Statistical analysis was carried out using IBM SPSS Version 26, with p < 0.05 considered statistically significant. Results: Of the 1,659 admitted patients, 395 (23.8%) developed HAI during the study period. After excluding patients with incomplete medical records and those with fungal or viral infections, 363 patients remained. The majority of these cases occurred in male patients. The most common type of HAI was burn wound infection (56.2%). Patients were mainly affected by Gram-negative bacteria, Pseudomonas aeruginosa (39.7%), while the most common Gram-positive bacteria was Staphylococcus epidermididis (9.6%). The most common antibiotic resistance among P. aeruginosa-infected patients was reported against imipenem, followed by gentamicin and ciprofloxacin; however, the mentioned organism was mainly sensitive to colistin. Gender, age, bloodstream infection (BSI), ventilator-associated infection (VAI), ICU admission, and total burned surface area (TBSA) resulted in 3.585, 1.028, 2.222, 7.469, 5.278-, and 1.031 times higher mortality rates, respectively. Conclusion: Female gender, advanced age, BSI, VAI, and ICU admission are risk factors for HAI. These findings emphasize the need for focused infection prevention and management to improve high-risk burn patient survival.

Disinfectants efficacy in reducing pathogens related to health-care infection associated in universities hospitals of Gorgan, North of Iran

BACKGROUND

Disinfection has a fundamental role in the control of pathogens in the hospital environment. This study was designed to assess the efficacy and functional impact of disinfectants in reducing pathogens related to healthcare associated infections (HAIs) in hospitals.

METHODS

This observation study was conducted at three university hospitals in Gorgan, Iran, from May to Oct 2023. The data including used disinfectants and microbiological examination were obtained from the infection control unit of each hospital.

RESULTS

The results showed that a variety of disinfectants from intermediate to high levels were employed in accordance with the World Health Organization (WHO) protocols. The microbial result revealed that 31.6% (286 out of 906) of the sample had at least one microorganism. Among identified organisms, Bacillus spp. were the predominant species followed by Staphylococcus epidermis, fungus genera, Enterobacter spp., Enterococcus spp., Pseudomonas spp., Escherichia coli, Alcaligenes spp., Staphylococcus aureus, Citrobacter spp., Corynebacterium spp., Klebsiella spp., Acinetobacter spp., Micrococcus spp., Staphylococcus saprophyticus, and Serratias spp. The highest prevalence rates of microorganisms were observed in the wards of ICU, emergency, internal medicine, and women's ward. The chi-square test revealed a significant relationship between the presence of organisms and hospital wards (P < 0.05).

CONCLUSION

The presence of pathogens indicates a defect in the disinfection process, probably due to both little attention to disinfection protocols and multidrug resistance. It is not yet possible to eliminate pathogens from the hospital environment, but it can be minimized by education intervention, standardizing disinfecting processes, and monitoring by the infection control committee.

Nosocomial carbapenem-drug resistant Acinetobacter baumannii, related factors and clinical outcomes in Northeast Iran

BACKGROUND AND OBJECTIVES

Nosocomial infections, including drug-resistant Acinetobacter baumannii infections, continue to impact the health of hospitalized patients. This study sought to determine the prevalence of these infections and assess the associated risk factors and clinical outcomes in Gorgan, Iran.

METHODS

A retrospective cross-sectional study was conducted on 143 infected patients with Acinetobacter baumannii in two educational hospitals in Gorgan city, Iran between 2016 and 2018. Patient information including age, gender, reason and duration of hospitalization, background of diseases, type of sample culture, symptoms, laboratory findings, prescribed antibiotics, and antibiogram were collected and analyzed. The Logistic regression and survival statistical methods were used by software of SPSS 26.

RESULTS

A total of 37 patients (25.87%) died during hospitalization. The less than one year and 45-65 years age groups demonstrated more deaths (29.7%; p-value < 0.001). Being single (not being married) was found to be a risk factor in increasing the chance of death among patients (OR = 2.154, 95% CI: 1.02-4.53; p = 0.048). Hospitalization in intensive care units (ICUs) was a risk factor for the death of patients (OR = 4.655, 95% CI: 7.6-83.2). The resistance to carbapenems was reported to be an important risk factor for the death of patients.

CONCLUSIONS

Acinetobacter baumannii infections, particularly those resistant to carbapenems, are a significant risk for patients in ICUs and can lead to higher mortality rates.

Beyond the distance between juridic and scientific decision-making process: An evidence-based prediction algorithm for professional liability assessment in healthcare-associated infections

BACKGROUND

HAIs (Healthcare-Acquired-Infections) have been recently the subject of judgment n. 6386 pronounced on 3rd March 2023 by the Italian Supreme Court. This sentence provided three criteria to determine whether a health facility is responsible for the patient contracting a nosocomial infection, i.e. time criterion, topographical criterion and clinical criterion. Accordingly, the healthcare facility is obliged to prove the fulfillment of a series of preventive hygiene measures specifically detailed by the legislator. Herein, the positive predictive value of these criteria ("juridic criteria") in the identification of professional liability for nosocomial infections was evaluated in comparison with clinical criteria reviewed by Infectious Disease specialists ("Infectious-Disease criteria", i.e. presence of a Multidrug Resistant Organism (MDRO); development of surgical site infection; inadequate antibiotic therapy; inadequate disinfection).

METHODS

Two retrospective cohorts were compared from the Portal of Telematic Services of the Ministry of Justice; 51 patients were extrapolated from Italian judgments concerning claims for Gram-negative nosocomial infections in the three-year period 2020-2022. On the other side, from the electronic database of University Hospital of Bari we extracted 349 patients affected by Gram-negative infections in the same timespan. Both "juridic" criteria and "Infectious-Disease" criteria were then applied to the full cohort after stratification for cohort of origin and after stratification for nosocomial or non-nosocomial infections. Predictive value of criteria was evaluated through receiver operating characteristic (ROC) curves and area under the curve (AUC).

RESULTS

Overall, the incidence of definite nosocomial infections (according to final judgement or clinical records discharge letter) was 84 % in juridic cohort and 46 % in "real-world" series. Data suggested that the presence of all three juridic criteria [ROC AUC = 0.944 (95%CI = 0.924-0.963)] or the four clinical criteria [ROC AUC = 0.948 (95%CI = 0.928-0.969)] predicted well a case of nosocomial infection with professional liability. Moreover, by summarizing both criteria in a single classification system, the generated ROC curve (was the one with the highest AUC [0.9488 (95%CI = 0.928-0.969)]. Accordingly, further tests were performed, evaluating the predictive value of one juridic criterium plus at one of more Infectious-Disease criteria. Interestingly, the ROCs curves demonstrated that the presence of at least 1 juridic criteria plus at least 2 Infectious Disease criteria reached a predictive value comparable to 2 or 3 juridic criteria.

CONCLUSIONS

The results highlight the efficiency of new criteria laid down in the judgment of the Italian Supreme Court to attribute liability for nosocomial infection despite the disputed distance between juridic and scientific decision-making process. In addition, the use of a combined score combining "juridic" and "Infectious-Disease" criteria provides a high-quality tool to be used by technical consultants to make up for lack of clinical documentation by passing judgments concerning litigation about professional liability in case of nosocomial infections. This sheds light on the possibility to face worldwide judicial inquiries with scientific rigor.

Establishment of a Pseudomonas aeruginosa Biofilm Model Using a Drip Flow Reactor: Evaluation of Antibiotic Efficacy against Biofilm Formation and Destruction

Background:

Pseudomonas aeruginosa (PA) is a significant cause of nosocomial infections, particularly because its ability to form biofilms on medical devices complicates treatment. This study developed a biofilm model using a drip flow reactor (DFR) system and apply it to investigate the effects of antibiotics on biofilm formation.

Methods:

The biofilm-forming capacity of PA strains ATCC 9027, ATCC 27853, and PA 01 (a PA isolate from wastewater samples) was evaluated using a DFR system. This model was then used to assess biofilm resistance to antibiotics through flow cytometry analysis.

Results:

A PA biofilm model was successfully established in the DFR system, as evidenced by images of the carrier and flow cytometry analysis results. Significant differences in biofilm formation were observed among the tested strains (one-way ANOVA, P < 0.01). The timing of antibiotic administration was found to influence biofilm formation. The combination of colistin and rifampicin exerted a synergistic effect, significantly enhancing both the inhibition of biofilm formation and the destruction of existing biofilms compared with individual antibiotic treatments (one-way ANOVA, P < 0.01).

Conclusion:

This study successfully developed a PA biofilm model using the DFR system and applied it to evaluate the efficacy of colistin and rifampicin, both individually and in combination, against PA biofilms. The DFR model, coupled with flow cytometry analysis, is a valuable tool for investigating biofilm formation kinetics and assessing the impact of antibiotics on biofilm development and eradication.

Infection Prevention: The Small but Mighty Teams in Health Care

Description Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.

Polymyxin B Peptide Hydrogel Coating: A Novel Approach to Prevent Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) remains one of the most common hospital-acquired infections (HAI). Considering the complicated diagnosis and the lack of effective treatment, prophylactic measures are suggested as the new standard to prevent the disease. Although VAP often manifests a polymicrobial nature, Pseudomonas aeruginosa remains one of the pathogens associated with the highest morbidity and mortality rates within these mechanically ventilated patients. In this paper, we report on the development of an antibacterial hydrogel coating using the polymyxin B (PMB) peptide to prevent bacterial adhesion to the polymeric substrate. We fully characterized the properties of the coating using atomic force microscopy (AFM), scanning electron microscopy (SEM), wettability analyses and Fourier-transform infrared (FTIR) and Raman spectroscopy. Furthermore, several biological assays confirmed the antibacterial and anti-biofilm effect of the tubing for at least 8 days against P. aeruginosa. On top of that, the produced coating is compliant with the requirements regarding cytocompatibility stated in the ISO (International Organization for Standardization) 10993 guidelines and an extended release of PMB over a period of at least 42 days was detected. In conclusion, this study serves as a foundation for peptide-releasing hydrogel formulas in the prevention of VAP.

Impact of ESKAPE Pathogens on Bacteremia: A Three-Year Surveillance Study at a Major Hospital in Southern Italy

BACKGROUND/OBJECTIVES

ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pose a serious public health threat as they are resistant to multiple antimicrobial agents. Bloodstream infections (BSIs) caused by ESKAPE bacteria have high mortality rates due to the limited availability of effective antimicrobials. This study aimed to evaluate the prevalence and susceptibility of ESKAPE pathogens causing BSIs over three years in a large tertiary hospital in Salerno.

METHODS

Conducted at the Clinical Microbiology Laboratory of San Giovanni di Dio e ''Ruggi D'Aragona'' Hospital from January 2020 to December 2022, blood culture samples from different departments were incubated in the BD BACTEC™ system for 5 days. Species identification was performed using MALDI-TOF MS, and antimicrobial resistance patterns were determined by the VITEK2 system.

RESULTS

Out of 3197 species isolated from positive blood cultures, 38.7% were ESKAPE bacteria. Of these, 59.9% were found in blood culture samples taken from men, and the most affected age group was those aged >60 years. (70.6%). Staphylococcus aureus was the main BSI pathogen (26.3%), followed by Klebsiella pneumoniae (15.8%). Significant resistance rates were found, including 35% of Staphylococcus aureus being resistant to oxacillin and over 90% of Acinetobacter baumannii being resistant to carbapenems.

CONCLUSIONS

These results highlight the urgent need for antimicrobial stewardship programs to prevent incurable infections.

Nebulized Lipopolysaccharide Causes Delayed Cortical Neuroinflammation in a Murine Model of Acute Lung Injury

Lung injury caused by respiratory infection is a major cause of hospitalization and mortality and a leading origin of sepsis. Sepsis-associated encephalopathy and delirium are frequent complications in patients with severe lung injury, yet the pathogenetic mechanisms remain unclear. Here, 70 female C57BL/6 mice were subjected to a single full-body-exposure with nebulized lipopolysaccharide (LPS). Neuromotor impairment was assessed repeatedly and brain, blood, and lung samples were analyzed at survival points of 24 h, 48 h, 72 h, and 96 h after exposure. qRT-PCR revealed increased mRNA-expression of TNFα and IL-1β 24 h and 48 h after LPS-exposure in the lung, concomitantly with increased amounts of proteins in bronchoalveolar lavage and interstitial lung edema. In the cerebral cortex, at 72 h and/or 96 h after LPS exposure, the inflammation- and activity-associated markers TLR4, GFAP, Gadd45b, c-Fos, and Arc were increased. Therefore, single exposure to nebulized LPS not only triggers an early inflammatory reaction in the lung but also induces a delayed neuroinflammatory response. The identified mechanisms provide new insights into the pathogenesis of sepsis-associated encephalopathy and might serve as targets for future therapeutic approaches.

Incidence and Predictors of Healthcare-Associated Infections in Patients Admitted to a Temporary Intensive Care Unit during the COVID-19 Pandemic Waves: A Two-Year (2021-2023) Retrospective Cohort Study in Rome, Italy

To manage the number of critical COVID-19 patients, Umberto I Teaching Hospital in Rome established a temporary ICU on March 1, 2021. This study investigated the incidence and risk factors of healthcare-associated infections (HAIs) among these patients during various COVID-19 waves. Patients were grouped by admission date according to the dominant SARS-CoV-2 variant prevalent at the time (Alpha, Delta, Omicron BA.1, Omicron BA.2, Omicron BA.5, and Omicron XBB). First-HAI and mortality rates were calculated per 1000 patient-days. Predictors of first-HAI occurrence were investigated using a multivariable Fine-Gray regression model considering death as a competing event. Among 355 admitted patients, 27.3% experienced at least one HAI, and 49.6% died. Patient characteristics varied over time, with older and more complex cases in the later phases, while HAI and mortality rates were higher in the first year. Pathogens responsible for HAIs varied over time, with first Acinetobacter baumannii and then Klebsiella pneumoniae being progressively predominant. Multivariable analysis confirmed that, compared to Alpha, admission during the Omicron BA.1, BA.2, BA.5, and XBB periods was associated with lower hazards of HAI. Despite worsening COVID-19 patient conditions, late-phase HAI rates decreased, likely due to evolving pathogen characteristics, improved immunity, but also better clinical management, and adherence to infection prevention practices. Enhanced HAI prevention in emergency situations is crucial.

The Effect of Simulation-Based Training on the Hand Hygiene Knowledge and Practices of Palliative Caregivers: A Double-Blind, Randomized, Controlled Single-Center Study

This study aimed to investigate the effect of simulation-based training on hand hygiene knowledge and practices among palliative caregivers. The study was conducted with 60 caregivers in a palliative care clinic between December 2022 and September 2023. The participants were divided into two groups by simple randomization. The intervention and control groups received the same hand hygiene theoretical education and demonstration. The intervention group also received additional simulation-based hand hygiene practices recommended by the World Health Organization. A pretest-posttest design was used to assess hand hygiene knowledge and practices. Data were collected with personal information, hand hygiene knowledge, and hand hygiene practice forms. Analysis of covariance was performed to compare posttest scores between the groups. Simulation-based hand hygiene training programs offer an effective and feasible strategy to improve the hand hygiene knowledge and practices of caregivers. It should be integrated into clinical areas to increase palliative caregivers' hand hygiene knowledge and practices. Evidence-based practices can be improved by increasing randomized controlled studies on the effectiveness of simulation-based hand hygiene training for caregivers. Trial Registration: The study was registered at ClinicalTrials.gov with registration number NCT05848596.

Antimicrobial Resistance Profiles of Pseudomonas aeruginosa in the Arabian Gulf Region Over a 12-Year Period (2010-2021)

OBJECTIVES

To evaluate literature from a 12-year period (2010-2021) on the antimicrobial resistance profile of Pseudomonas aeruginosa from the Arabian Gulf countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates).

METHODS

An electronic literature search was conducted for articles on antimicrobial resistance in P. aeruginosa and associated phenotypes, covering the period of 1st January 2010 to 1st December 2021.

RESULTS

Antimicrobial resistance in the Arabian Gulf was highest to meropenem (10.3-45.7%) and lowest to colistin (0.0-0.8%), among the agents tested. Annual data showed that ceftazidime resistance (Kuwait), piperacillin-tazobactam non-susceptibility (Qatar), and aztreonam, imipenem, and meropenem resistance (Saudi Arabia) increased by 12-17%. Multiple mechanisms of carbapenem resistance were identified and multiple clones were detected, including high-risk clones such as ST235. The most common carbapenemases detected were the VIM-type metallo-β-lactamases.

CONCLUSIONS

Among P. aeruginosa in the Arabian Gulf countries, resistance to meropenem was higher than to the other agents tested, and meropenem resistance increased in Saudi Arabia during the study period. Resistance to colistin, a classic antibiotic used to treat Pseudomonas spp. infections, remained low. The VIM-type β-lactamase genes were dominant. We recommend local and regional antimicrobial resistance surveillance programs to detect the emergence of resistance genes and to monitor antimicrobial resistance trends in P. aeruginosa.

Anti-Biofilm and Anti-Inflammatory Properties of the Truncated Analogs of the Scorpion Venom-Derived Peptide IsCT against Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen in humans and a frequent cause of severe nosocomial infections and fatal infections in immunocompromised individuals. Its ability to form biofilms has been the main driving force behind its resistance to almost all conventional antibiotics, thereby limiting treatment efficacy. In an effort to discover novel therapeutic agents to fight P. aeruginosa-associated biofilm infections, the truncated analogs of scorpion venom-derived peptide IsCT were synthesized and their anti-biofilm properties were examined. Among the investigated peptides, the IsCT-Δ6-8 peptide evidently showed the most potential anti-P. aeruginosa biofilm activity and the effect was not due to bacterial growth inhibition. The IsCT-Δ6-8 peptide also exhibited inhibitory activity against the production of pyocyanin, an important virulence factor of P. aeruginosa. Furthermore, the IsCT-Δ6-8 peptide significantly suppressed the production of inflammatory mediators nitric oxide and interleukin-6 in P. aeruginosa LPS-induced macrophages. Due to its low cytotoxicity to mammalian cells, the IsCT-Δ6-8 peptide emerges as a promising candidate with significant anti-biofilm and anti-inflammatory properties. These findings highlight its potential application in treating P. aeruginosa-related biofilm infections.

The Most Common Multi-Drug Resistant Bacteria Associated with Hospital Infections, in Urmia, Iran

Background & Objective

Hospital-acquired infections (HAIs) are a major healthcare problem in hospitalized patients, especially in developing countries, where they affect millions of patients and cause high mortality rates. This study aimed to investigate multidrug-resistant bacterial strains in NIs at Imam Khomeini University Hospital in Urmia, Iran.

Methods

This cross-sectional study was conducted using a convenience sampling method. The study population comprised all positive clinical samples from HAIs registered in the laboratory of Imam Khomeini Hospital, Urmia, Iran, in 2019. Bacteria were identified by culturing the samples on blood agar and MacConkey agar, followed by performing standard biochemical tests. Antibiotic susceptibility testing was carried out using the disk diffusion method, in accordance with CLSI guidelines.

Results

Of the 607 positive samples, the most common microorganisms isolated were Escherichia coli (27.5%), Acinetobacter baumannii (18.5%), and Klebsiella pneumoniae (15.2%). The distribution of resistance to the number of antibiotics in bacterial isolates from the samples showed that 19.8% of them were resistant to one antibiotic and 13.2% were resistant to three antibiotics. 40.5% of the samples showed no resistance to antibiotics.

Conclusion

This study highlights the critical issue of HAIs and the prevalence of multidrug-resistant bacteria in Urmia, Iran. Urgent measures, including improved hygiene, accurate diagnostics, appropriate antibiotic use, and stakeholder education, are essential. Establishing a robust HAI surveillance system is also recommended. Future efforts should aim at understanding and mitigating the spread of these pathogens.

16S rRNA amplicon sequencing and antimicrobial resistance profile of intensive care units environment in 41 Brazilian hospitals

Introduction

Infections acquired during healthcare setting stay pose significant public health threats. These infections are known as Healthcare-Associated Infections (HAI), mostly caused by pathogenic bacteria, which exhibit a wide range of antimicrobial resistance. Currently, there is no knowledge about the global cleaning process of hospitals and the bacterial diversity found in ICUs of Brazilian hospitals contributing to HAI.

Objective

Characterize the microbiome and common antimicrobial resistance genes present in high-touch Intensive Care Unit (ICU) surfaces, and to identify the potential contamination of the sanitizers/processes used to clean hospital surfaces.

Methods

In this national, multicenter, observational, and prospective cohort, bacterial profiles and several antimicrobial resistance genes from 41 hospitals across 16 Brazilian states were evaluated. Using high-throughput 16S rRNA amplicon sequencing and real-time PCR, the bacterial abundance and resistance genes presence were analyzed in both ICU environments and cleaning products.

Results

We identified a wide diversity of microbial populations with a recurring presence of HAI-related bacteria among most of the hospitals. The median bacterial positivity rate in surface samples was high (88.24%), varying from 21.62 to 100% in different hospitals. Hospitals with the highest bacterial load in samples were also the ones with highest HAI-related abundances. Streptococcus spp., Corynebacterium spp., Staphylococcus spp., Bacillus spp., Acinetobacter spp., and bacteria from the Flavobacteriaceae family were the microorganisms most found across all hospitals. Despite each hospital particularities in bacterial composition, clustering profiles were found for surfaces and locations in the ICU. Antimicrobial resistance genes mecA, bla KPC-like, bla NDM-like, and bla OXA-23-like were the most frequently detected in surface samples. A wide variety of sanitizers were collected, with 19 different active principles in-use, and 21% of the solutions collected showed viable bacterial growth with antimicrobial resistance genes detected.

Conclusion

This study demonstrated a diverse and spread pattern of bacteria and antimicrobial resistance genes covering a large part of the national territory in ICU surface samples and in sanitizers solutions. This data should contribute to the adoption of surveillance programs to improve HAI control strategies and demonstrate that large-scale epidemiology studies must be performed to further understand the implications of bacterial contamination in hospital surfaces and sanitizer solutions.

Accumulation and growth toxicity mechanisms of fluxapyroxad revealed by physiological, hepatopancreas transcriptome, and gut microbiome analysis in Pacific white shrimp (Litopenaeus vannamei)

Fluxapyroxad (FX), a typical succinate dehydrogenase inhibitor fungicide, is causing increased global concerns due to its fungicide effects. However, the accumulation and grow toxicity of FX to Litopenaeus vannamei (L. vannamei) is poorly understand. Therefore, the accumulation pattern of FX in L. vannamei was investigated for the first time in environmental concentrations. FX accumulated rapidly in shrimp muscle. Meanwhile, growth inhibition was observed and the mechanism derived by primarily accelerated glycolipid metabolism and reduced glycolipid content. Moreover, exposure to environmental concentrations of FX induced significant growth inhibition and oxidative stress and inhibited oxidative phosphorylation and TCA cycle in L. vannamei. The endocytosis signaling pathway genes were activated, thereby driving growth toxicity. Oxidative phosphorylation and cytosolic gene expression were further rescued in elimination experiments, demonstrating the mechanism of growth toxicity by FX exposure. The results revealed that FX persistently altered the gut microbiome of L. vannamei using gut microbiome sequencing, particularly with increased Garcinia Purple Pseudoalteromonas luteoviolacea for organic pollutant degradation. This study provided new insights into the potential toxicity of FX to marine organisms, emphasizing the need for further investigation and potential regulatory considerations.